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Nurusysyarifah Aliyyah; Promotor: Haryoto Kusnoputranto; Kopromotor: Bambang Wispriyono, Laila Fitria; Penguji: Mondastri Korib Sudaryo, Umar Fahmi Achmadi, Mukono; Syafruddin
Abstrak:

Hipertensi merupakan salah satu kondisi medis yang cukup serius karena dapat meningkatkan risiko penyakit jantung, otak, ginjal dan penyakit lainnya. Wilayah di DKI Jakarta dengan prevalensi hipertensi tertinggi berdasarkan diagnosis dokter yaitu Kota Jakarta Pusat sebesar 12,16%. Partikulat meter organik dan komponen partikulat meter dapat memicu proinflammatory effects pada paru-paru karena kemampuannya mengakibatkan stress oksidatif. Penelitian ini bertujuan untuk menyusun model pengaruh pajanan PM2,5 di udara ambien terhadap kejadian hipertensi melalui stress oksidatif dan sitokin inflamasi pada penduduk di Jakarta Pusat. Penelitian dilakukan pada penduduk dewasa (18-65 tahun) di Kota Jakarta Pusat dengan disain studi hybrid cross sectional ecology. Pengumpulan data secara cluster random sampling dengan analisis data dilakukan melalui pemodelan regresi logistik multilevel dan cox regresi proporsional hazard.
Hasil analisis menunjukkan terdapat asosiasi antara PM2,5 di udara ambien dengan biomarker stress oksidatif (IOR PM2,5: 2,185173-2,185176) dan dengan biomarker sitokin inflamasi (IOR PM2,5: 1,21-1,91). Pemodelan multivariat dengan cox regresi proporsional hazard menunjukkan bahwa variabel umur dan indeks massa tubuh merupakan confounder hubungan antara stress oksidatif dengan hipertensi dan antara sitokin inflamasi dengan hipertensi dengan nilai Rasio Prevalens adjusted (95% CI) masing-masing sebesar 1,19 (0,69-2,03) dan 0,99 (0,58-1,72). Dapat disimpulkan bahwa variabel konsentrasi PM2,5 di udara ambien memiliki peran terhadap terjadinya hipertensi, stress oksidatif dan sitokin inflamasi pada penduduk di Jakarta Pusat.

Hypertension is a serious medical condition that can increase the risk of heart, brain, kidney and other diseases. The area in DKI Jakarta with the highest prevalence of hypertension based on doctor diagnosis is Central Jakarta city about 12.16%. Organic particulate matters and particulate matter components can trigger proinflammatory efects in the lung due to their ability to cause oxidative stress. This study aims to develop a model of the Influence of PM2,5 Exposure in Ambient Air on Hypertension Occurrence through Oxidative Stress and Inflammatory Cytokines among residents in Central Jakarta. The study was conducted among adult residents (age 18-65 years) in Central Jakarta with hybrid cross sectional study design. Data collected using cluster random sampling with data analysis carried out through multilevel logistic regression modeling and cox proportional hazard regression. Results show there is an association between PM2.5 in ambient air with oxidative stress biomarkers (IOR PM2.5: 2.185173-2.185176) and with inflammatory cytokine biomarkers (IOR PM2.5: 1.21-1.91). Multivariate modeling with Cox regression proportional hazard shows that age and body mass index are confounders of the relationship between oxidative stress with hypertension and between inflammatory cytokines with hypertension with an adjusted prevalence ratio (95% CI) value of 1.19 (0.69-2.03) and 0.99 (0.58-1.72). It can conclude that concentration of PM2.5 in ambient air has a role on hypertension, oxidative stress and inflammatory cytokine among residents in Central Jakarta.

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D-519
Depok : FKM-UI, 2024
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Imelda Gernauli Purba; Promotor: Haryoto Kusnoputranto; Kopromotor: Budi Hartono, Ririn Arminsih Wulandari; Penguji: Bambang Wispriyono, Besral, Mukono, Yuanita Windusari, Rico Januar Sitorus
Abstrak:
ABSTRAK Pajanan organofosfat memicu peningkatan spesies oksigen reaktif, yang menyebabkan stres oksidatif. Stres oksidatif sistemik ini memicu respon peradangan, yang pada gilirannya berkontribusi terhadap patogenesis hipertensi. Penelitian ini bertujuan menganalisis hubungan pajanan organofosfat dengan stres oksidatif dan kejadian hipertensi pada petani di Kecamatan Dempo Utara  Pagar Alam. Desain penelitian ini adalah cross sectional, menggunakan metode analisis risiko kesehatan lingkungan dan epidemiologi kesehatan lingkungan. Sampel petani diambil secara simple random sampling, sebanyak 116 orang. Pemeriksaan residu organofosfat menggunakan LC-MS/MS, dialkil fosfat dengan GC-MS, malondialdehida dengan Spektro UV-Vis, serta tekanan darah menggunakan sphygmomanometer. Pengumpulan data karakteristik perilaku melalui wawancara menggunakan kuesioner. Analisis data menggunakan chi-square dan regresi logistik ganda. Hasil penelitian menunjukkan terdapat residu organofosfat pada beberapa sampel cabai dan tomat, namun belum menimbulkan risiko kesehatan berdasarkan hasil karakterisasi risiko. Terdapat interaksi  keberadaan dialkil fosfat dan lama menyemprot terhadap stres oksidatit (OR pada ≤ 4 jam/hari=0,73; OR pada ≥4 jam/hari= 0,83). Terdapat interaksi keberadaan dialkil fosfat dan frekuensi menyemprot terhadap stres oksidatif (OR pada<2 kali/minggu=0,73 dan OR pada ≥2 kali/minggu=0,045). Terdapat interaksi keberadaan dialkil fosfat dan lama menyemprot terhadap hipertensi (OR pada ≤4 jam/hari=2,57;dan OR pada >4 jam/hari=0,16). Stres oksidatif tidak berkorelasi  dengan kejadian hipertensi, namun terdapat faktor konfounding yaitu lama menyemprot (OR:3,69(1,46-9,36) dan umur (OR:3,54(1,39-9,07). Kesimpulan penelitian ini adalah lama dan frekuensi menyemprot menjadi effect modifier korelasi keberadaan dialkil fosfat dengan stres oksidatif, sementara lama menyemprot menjadi effect modifier korelasi keberadaan dialkil fosfat dengan kejadian hipertensi. Lama menyemprot dan umur menjadi confounder dalam hubungan stres oksidatif dengan kejadian hipertensi pada petani. Kata kunci : dialkil fosfat, hipertensi, organofosfat, model faktor risiko, risk quotient, stres oksidatif
Exposure to organophosphates triggers an increase in reactive oxygen species, which causes oxidative stress. This systemic oxidative stress triggers an inflammatory response, which in turn contributes to the pathogenesis of hypertension. This study aimed to analyze the relationship between organophosphate exposure, oxidative stress, and the incidence of hypertension among farmers in the Dempo Utara subdistrict of Pagar Alam. The study design is cross-sectional, employing methods of environmental health risk analysis and environmental health epidemiology. A sample of 116 farmers was selected using simple random sampling. Organophosphate residues were analyzed using LC-MS/MS; dialkyl phosphates using GC-MS; malondialdehyde levels were determined using UV-Vis spectroscopy; and blood pressure using a sphygmomanometer. Behavioral characteristics were collected through interviews using a questionnaire. Data analysis was performed using the chi-square test and multiple logistic regression. The results revealed the presence of organophosphate residues in some chili and tomato samples; however, these did not pose a health risk based on the risk characterization findings. There was an interaction between the presence of dialkyl phosphates and spraying duration regarding oxidative stress (OR for ≤ 4 hours/day = 0.73; OR for ≥ 4 hours/day = 0.83). There was an interaction between the presence of dialkyl phosphates and spraying frequency regarding oxidative stress (OR for <2 times/week = 0.73 and OR for ≥2 times/week = 0.045). There was an interaction between the presence of dialkyl phosphates and duration of spraying on the risk of hypertension (OR for ≤4 hours/day = 2.57; and OR for >4 hours/day = 0.16). Oxidative stress was not correlated with the incidence of hypertension; however, there were confounding factors, namely spraying duration (OR: 3.69 [1.46–9.36]) and age (OR: 3.54 [1.39–9.07]). The conclusion of this study is that spraying duration and frequency act as effect modifiers for the association between the presence of dialkyl phosphates and oxidative stress, while spraying duration acts as an effect modifier for the association between the presence of dialkyl phosphates and the incidence of hypertension. Spraying duration acts as a confounder in the relationship between oxidative stress and the incidence of hypertension among farmers. Keywords: dialkylphosphate, hypertension, organophosphate, oxidative stress, risk quotient, risk factor model
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D-654
Depok : FKM-UI, 2026
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Mery Ramadani; Promotor: Budi Utomo; Kopromotor: Endang Laksminingsih Achadi, Hartono Gunardi; Penguji: Anhari Achadi, Faisal Yunus, Besral, Bambang Wispriyono, Soewarta Kosen, Abas Basuni Jahari,
Abstrak: Rokok merupakan masalah global dan menjadi ancaman serius bagi kesehatan ibu hamil dan janin. Studi kohor prospektif ini, dilakukan untuk menilai pengaruh pajanan pasif asap rokok ibu hamil terhadap gangguan pertumbuhan janin. Melibatkan 128 ibu hamil trimester 3, hamil janin tunggal, tidak memiliki riwayat penyakit kronis, bukan perokok aktif, bukan mantan perokok, dan bersedia terlibat dalam penelitian. Penilaian pajanan asap rokok ibu berdasarkan pemeriksaan nikotin darah tali pusat (cut off ≥1ng/ml). Pengukuran menggunakan nikotin plasma adalah metode yang paling akurat karena dapat mengukur kondisi sebenarnya dan membantu mengurangi misklasifikasi. Gangguan pertumbuhan janin dinilai dengan pengukuran berat lahir, panjang lahir, lingkar kepala, dan berat plasenta. Pengukuran dilakukan segera setelah lahir untuk menjamin ketepatan pengukuran. Analisis uji beda dua mean digunakan untuk mengetahui perbedaan rata rata ukuran gangguan pertumbuhan janin antara kelompok ibu terpajan asap rokok dan tidak terpajan asap rokok. Analisis regresi linier untuk melihat pengaruh pajanan asap rokok terhadap berat lahir, panjang lahir, lingkar kepala dan berat plasenta dengan memperhatikan variabel pengganggu seperti penambahan berat badan ibu selama hamil, BMI ibu, paritas ibu, usia dan kadar hemoglobin ibu. Hasil penelitian menunjukkan rata-rata kadar nikotin tali pusat sebesar 1,3±2,5 ng/ml. Berat lahir dan berat plasenta bayi dari ibu yang mendapat pajanan asap rokok lebih rendah dibandingkan ibu yang tidak mendapat pajanan asap rokok. Pajanan asap rokok secara signifikan mengurangi berat lahir bayi sebesar 205,6 gram (pvalue = 0,005) dan berat plasenta sebesar 51 gram (p value=0,010).
 
This cohort study examined the effect of secondhand smoke exposure in pregnant women on fetal growth restriction. The study recruited 128 pregnant women in the third trimester pregnancy, single pregnancy, no chronic illness, non-active smokers, non-exsmokers, and who were willing to participate in the study. Pregnant women with the secondhand smoke exposure referred to those with the umbilical cord blood nicotine level of 1ng/ml or higher. Fetal growth disorder was assessed according to the newborn weight, length, head circumference, and palcental weight measured immediately after birth. The independent t-test analysis was used to determine the difference in average size of fetal growth between two groups of pregnant women: exposed and the notexposed to the secondhand smoke. A multiple linear regression analysis was employed to find out the effect of secondhand smoke exposure on birth weight, length, head circumference, and palcental weight controlling for the birth size confounders including weight gain during pregnancy, body mass index, parity, maternal age, and maternal hemoglobin. The study found that mean of nicotine in umbilical cord blood was 1.3±2.5 ng/ml, the birth weight and the placental weight of infants were lower among mothers who exposed than among mothers who did not expose to the secondhand smoke. Exposed to the secondhand smoke reduced the birth weight by 205.6 grams (p value = 0.005) and placental weight by 51 grams (p value=0.010).
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D-395
Depok : FKM-UI, 2019
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Nurfanida Librianty; Promotor: Bambang Wispriyono; Kopromotor: Haryoto Kusnoputranto, Anna Rozaliyani, Penguji: Faisal Yunus, Besral, Arief Budi Witarto
Abstrak: Pandemi Coronavirus diseases 2019 (COVID-19) membuat krisis kesehatan global. Pajanan lama PM, NO2, CO, O3 berefek negatif terhadap pasien COVID-19. Beberapa penelitian menunjukkan hubungan signifikan kerentanan genetik terhadap efek polutan udara terhadap penyakit, seperti pasien COVID-19 dengan polimorfisme ACE rs4646994 atau ACE2 rs2285666 dapat memiliki derajat lebih berat. Tujuan penelitian ini untuk menganalisis pengaruh pajanan PM2,5, NO2, O3, kondisi iklim, polimorfisme ACE rs4646994 dan ACE2 rs2285666, usia, IMT, serta komorbid hipertensi, penyakit jantung, asma dan DM terhadap derajat COVID-19. Data lingkungan didapatkan dari BMKG dan subjek berdomisili radius < 3 km dari Stasiun Metereologi Kemayoran dengan membagi menjadi kelompok pasien derajat asimtomatik-ringan dan sedang-berat. Pemeriksaan polimorfisme diambil dari sampel swab bukal. Data dilakukan analisis regresi logistik. Hasil penelitian ini mendapatkan pasien COVID-19 dengan polimorfisme ACE2 rs2285666 genotip AA akan berisiko 9,128 kali mengalami derajat lebih berat. Polimorfisme ACE rs4646994, pajanan PM2,5, NO2 serta komorbid tidak berhubungan signifikan dengan derajat COVID-19. Pajanan O3, temperatur rendah, kelembaban rata-rata tinggi, sedikit sinar matahari, dan IMT tinggi secara signifikan memperberat COVID-19 pada analisis bivariat. Penelitian ini menyimpulkan polimorfisme ACE2 rs2285666 genotip AA merupakan faktor risiko memberatnya derajat COVID-19. Pajanan O3, IMT, temperatur minimum, temperatur rata-rata, kelembaban rata-rata dan lama penyinaran matahari dapat berperan terhadap derajat COVID-19.
Coronavirus Disease 2019 (COVID-19) pandemic created a global health crisis. Prolonged exposure to PM, NO2, CO, O3 has a negative effect on COVID-19 patients. Several studies have shown a significant relationship between genetic susceptibility to the effects of air pollutants on disease, such as COVID-19 patients with ACE rs4646994 or ACE2 rs2285666 polymorphisms can have a more severe degree. The aim of this study was to analyze the effect of exposure to PM2.5, NO2, O3, weather conditions, ACE rs4646994 and ACE2 rs2285666 polymorphisms, age, BMI, and comorbidities (hypertension, heart disease, asthma, and DM) on the degree of COVID-19. Environmental data were obtained from the BMKG and the subjects were domiciled within a radius of <3 km from the Kemayoran Meteorological Station by dividing the patients into asymptomatic-mild and moderate-severe groups. Polymorphism examination was taken from a buccal swab sample. Logistic regression was used to analyze the data. The results of this study found that COVID-19 patients with the polymorphism ACE2 rs2285666 genotype AA would be 9.128 times more at risk of experiencing a more severe degree. Polymorphism ACE rs4646994, exposure to PM2.5, NO2 and comorbidities were not significantly related to the degree of COVID-19. O3 exposure, low temperature, high average humidity, fewer durations of sunlight, and high BMI significantly aggravate COVID-19 in bivariate analysis. This study concluded that the polymorphism ACE2 rs2285666 genotype AA is a risk factor for the severity of COVID-19. Exposure to O3, BMI, minimum temperature, average temperature, average humidity, and duration of sunlight can play a role in the degree of COVID-19.
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D-473
Depok : FKM UI, 2023
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Rico Kurniawan; Promotor: Budi Utomo; Kopromotor: Kemal Nazaruddin Siregar, Kalamullah Ramli; Penguji: Anhari Achadi, Besral, Tris Eryando, Soewarta Kosen; Ruddy J. Suhatril
Abstrak:
Penelitian ini berfokus pada deteksi dini hipertensi untuk mengurangi risiko penyakit kardiovaskular. Menggunakan data Indonesia Family Life Survey, penelitian ini mengidentifikasi faktor seperti umur, gender, indeks massa tubuh, aktivitas fisik, dan denyut nadi sebagai prediktor utama hipertensi. Analisis menggunakan regresi panel multivariable dengan model fixed effect dan random effect menentukan variabel signifikan dalam variabilitas tekanan darah. Model Markov Multi Status digunakan untuk menghitung probabilitas perubahan status tekanan darah. Hasil menunjukkan bahwa model machine learning dengan algoritma regresi logistik efektif dalam mengklasifikasi hipertensi di Indonesia, ditunjukkan dengan nilai Area Under Curve (0.751 untuk pria dan 0.794 untuk wanita) dan Complete Accuracy yang tinggi (0.780 untuk pria dan 0.798 untuk wanita).. Model ini menggunakan prediktor non-invasif yang mudah diukur, dan algoritma regresi linier menunjukkan kinerja yang baik untuk data kontinu. Studi ini juga mengungkapkan probabilitas transisi tekanan darah dari normal ke hipertensi, pre hipertensi menjadi normal atau hipertensi, dan kemungkinan individu hipertensi untuk tetap dalam kondisi tersebut atau berubah status.Kesimpulan dari penelitian adalah metode deteksi ini efisien untuk lingkungan dengan sumber daya terbatas dan dapat diintegrasikan dalam program kesehatan masyarakat. Faktor sosiodemografi dan antropometri efektif sebagai estimator dalam prediksi status hipertensi.
This study focuses on early detection of hypertension to reduce cardiovascular disease risks. Utilizing data from the Indonesia Family Life Survey, it identifies key predictors of hypertension such as age, gender, body mass index, physical activity, and pulse rate. Multivariable panel regression analysis employing both fixed effect and random effect models was conducted to determine significant variables influencing blood pressure variability. A Markov Multi Status model was used to calculate the probabilities of transitioning between different blood pressure statuses. The results demonstrate that the machine learning model, employing logistic regression algorithms, is effective in classifying hypertension in Indonesia, evidenced by high Area Under Curve and Complete Accuracy values. This model utilizes easily measurable, non-invasive predictors. Moreover, the linear regression algorithm showed superior performance for continuous data. The study also reveals the probabilities of transitioning from normal to hypertensive states, from pre-hypertension to normal or hypertension, and the likelihood of individuals with hypertension maintaining or changing their status. In conclusion, this detection method is efficient for resource-limited environments and can be integrated into broader public health programs. Socio-demographic and anthropometric factors are effective as estimators in predicting hypertension status.
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D-495
Depok : FKM-UI, 2024
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Eviana Sumarti Tambunan; Promotor: Hadi Pratomo; Kopromotor: Ella Nurlaela Hadi, Yeni Rustina; Penguji: Asri C Adisasmista, Sutanto Priyo Hastono, Nani Dharmasetyawani, Setyadewi Lusyati, Ade Iva Wicaksono
Abstrak: Pendidikan kesehatan pada ibu dapat meningkatkan praktik perawatan bayi berat lahir rendah (BBLR), namun kemampuan ibu untuk melakukan praktik perawatan BBLR di rumah belum banyak digali. Penelitian ini bertujuan untuk menilai pengaruh paket pendidikan kesehatan pada ibu terhadap praktik perawatan BBLR di Jakarta Pusat. Penelitian dilakukan terhadap 159 ibu dengan BBLR yang bayinya dinyatakan boleh pulang dari ruang Perinatologi dengan pendekatan quasi eksperimen (78 ibu kelompok intervensi dan 81 ibu kelompok kontrol) dan teknik pengambilan sampel secara consecutive sampling. Ibu dengan BBLR yang berdomisili di wilayah intervensi mendapatkan paket pendidikan kesehatan yang diberikan oleh perawat puskesmas.
 
 
Paket pendidikan kesehatan terdiri dari penyuluhan tentang perawatan BBLR, yang diberikan pada 3-5 hari setelah BBLR keluar RS dan pendampingan pada ibu dan keluarga pada minggu ke-2 dan ke-6 setelah penyuluhan atau pengukuran awal. Ibu yang berdomisili di wilayah kontrol mendapatkan booklet tentang perawatan BBLR. Kedua kelompok dilakukan pengukuran dengan waktu yang sama sebanyak 4x yaitu 3 hari setelah keluar RS, 2, 6 dan 12 minggu setelah penyuluhan atau pengukuran awal. Pengumpulan data kualitatif juga dilakukan untuk melengkapi informasi yang diperlukan setelah mendapatkan gambaran hasil kuantitaif. Analisis multvariat dilakukan dengan Regresi Linier Ganda General Estimating Equation (GEE).
 
 
Hasil memperlihatkan pemberian paket pendidikan kesehatan pada ibu dengan BBLR memberikan efek peningkatan praktik ibu dalam perawatan BBLR sebesar 25,19%. Praktik perawatan BBLR pada ibu di kelompok intervensi lebih tinggi dibandingkan kelompok kontrol pada setiap waktu pengukuran (p=0,000). Variabel sikap dan dukungan kader kesehatan yang dilatih merupakan konfonder yang mempengaruhi hubungan pendidikan kesehatan terhadap praktik ibu dalam perawatan BBLR.
 
 
Kesimpulan: Pemberian paket pendidikan kesehatan yang dilakukan berkelanjutan selama 6 minggu berdampak efektif terhadap peningkatan praktik perawatan BBLR di rumah dan terhadap peningkatan status kesehatan bayi. Paket pendidikan kesehatan dapat dikembangkan di komunitas dengan melibatkan kader kesehatan untuk memberikan pendampingan pada ibu dengan BBLR diwilayahnya. Pelatihan ataupun sosialisasi tentang perawatan BBLR perlu diberikan pada tenaga kesehatan puskesmas dan kader kesehatan, sehingga dapat melakukan pendampingan secara tepat pada ibu dengan BBLR.
 
 
Health education for mothers can improve low birth weight (LBW) infant care practices. Yet, the ability of mothers to exercise LBW infant care at home has not been much explored. This study aims to assess the effect of health education packages on mothers towards LBW infant care practices in Central Jakarta. The study was conducted on 159 LBW mothers whose babies were permitted to return from the perinatology room with a quasi-experimental approach (78 mothers in the intervention group and 81 mothers in the control group). The sampling technique of this study was consecutive sampling. LBW mothers who were domiciled in the intervention areas received health education packages provided by nurses in health centers.
 
 
The health education package consisted of counseling on LBW care given in 3-5 days after LBW infant out of the hospital and mentoring for mothers and families at the 2nd and 6th weeks after counseling or initial measuring. Mothers who lived in the control area received a booklet on LBW infant care. The two groups were measured with the same time as much as 4 times, which was 3 days after leaving the hospital, 2, 6 and 12 weeks after counseling or the initial measurements. Qualitative data collection were also done to complete the information needed after getting a picture of the quantitative results. Multivariate analysis was carried out with Multiple Linear Regression General Estimating Equation (GEE).
 
 
The results showed the provision of health education packages to mothers with LBW have an effect to increase the practice of mothers in LBW infant care by 25.19%. The practice of LBW infant care among mothers in intervention group were higher than those in control groups at each measurement (p = 0,000). The attitude and support of trained health cadres variable are confounders that influence the relationship of health education to the practice of mothers in LBW care.
 
 
Conclusion: The provision of health education packages carried out continuously for 6 weeks has an effective impact on improving the practice of LBW infant care at home and has an impact on improving the health status of infants. Community-based health education packages developed by involving health cadres to provide assistance to mothers with LBW infant in their area. Training or socialization of LBW infant care to be given to health center workers and cadres, so they could provide appropriate assistance to LBW mothers.
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D-402
Depok : FKM-UI, 2019
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Putri Ayuni Alayyannur; Promotor: Doni Hikmat Ramdhan; Kopromotor: L. Meily Widjaja, Tri Martiana; Penguji: Laila Fitria, Mila Tejamaya, Robiana Modjo, Iting Shofwati
Abstrak:
Pendahuluan: Pajanan panas pekerjaan sebagai salah satu faktor risiko indikasi gangguan fungsi ginjal di berbagai studi. Nelayan dan pekerja pemindang termasuk pekerja berisiko terpajan panas. Studi ini akan mengembangkan model kontribusi pajanan panas pekerjaan pada indikasi gangguan fungsi ginjal pada pekerja di sektor perikanan Jawa Timur. Metode: Desain penelitian ini adalah cross sectional pada pekerja sektor perikanan Kabupaten Lamongan di Desember 2022-Februari 2023. Besar sampel 150 nelayan dan pemindang yang didapat dengan rumus uji hipotesis untuk proporsi populasi tunggal. Variabel yang diteliti meliputi faktor personal (usia, jenis kelamin, penyakit komorbid, antropometri, konsumsi obat. waktu istirahat, konsumsi air putih, konsumsi minuman manis, konsumsi minuman bersoda, konsumsi minuman berenergi, konsumsi kopi, konsumsi teh, konsumsi legen, dan konsumsi tuak), faktor pekerjaan (jenis pekerjaaan, masa kerja, beban kerja, dan pakaian kerja), faktor iklim (temperatur, kelembaban, dan kecepatan angin), pajanan panas, tekanan panas, dan indikasi gangguan fungsi ginjal (eGFR CKD-EPI dan uKIM-1). Pengumpulan data menggunakan sampel urin, sampel darah, heat stress monitor, sphygmomanometer, oximeter, microtoise, timbangan badan, dan kuesioner. Analisis data bivariat menggunakan t-test sampel independen dan uji ChiSquare, sedangkan uji multivariat menggunakan cox regression. Hasil: Usia, konsumsi air putih, konsumsi teh, jenis pekerjaan, masa kerja, beban kerja (%CVL), pakaian kerja, tekanan panas, dan dehidrasi (BJU) berhubungan dengan indikasi gangguan fungsi ginjal eGFR (CKD-EPI). Konsumsi air putih, konsumsi minuman manis, dan beban kerja (observasi) berhubungan dengan indikasi gangguan fungsi ginjal uKIM-1 . Model yang terbentuk adalah HeGFR(t) = h0 (t) exp (0,393 pajanan panas pekerjaan + 0,551 konsumsi air putih + 0,339 konsumsi kopi + 1,446 beban kerja (%CVL) + 0,865 pakaian kerja) Kesimpulan: pajanan panas pekerjaan merupakan faktor risiko terjadinya indikasi gangguan fungsi ginjal eGFR (CKD-EPI), dengan turut mempertimbangkan faktor yang lain yaitu konsumsi air putih, konsumsi kopi, beban kerja (%CVL), dan pakaian kerja. Oleh karena itu, perlu aktivasi Pos UKK untuk memberdayakan pekerja dalam melakukan kegiatan keselamatan dan kesehatan kerja.
Introduction: Occupational heat exposure can pose a significant risk to workers' health, especially regarding their kidney function. Studies have shown fishermen and pemindang workers are particularly vulnerable to heat exposure. To address this issue, a study is being conducted to develop a model that examines the impact of occupational heat exposure on kidney function in workers within the East Java fisheries sector. Method: This research design is cross-sectional among fisheries sector workers in Lamongan District in December 2022 to February 2023. The sample size is 150 fishermen and pemindang was obtained using the hypothesis testing formula for a single population proportion. The variables studied included personal factors (age, gender, comorbid diseases, anthropometry, drug consumption, rest time, water consumption, consumption of sweet drinks, consumption of fizzy drinks, consumption of energy drinks, consumption of coffee, consumption of tea, consumption of legumes, and consumption of palm wine), work factors (type of work, length of work, workload, and work clothing), climate factors (temperature, humidity, and wind speed), heat exposure, heat stress, and indications of impaired kidney function (eGFR CKD-EPI and uKIM-1). Data collection uses urine samples, blood samples, heat stress monitor, sphygmomanometer, oximeter, microtoise, body weighing, and questionnaires. Bivariate data analysis uses the independent samples t-test and Chi-Square test, while the multivariate test uses cox regression. Results: Age, water consumption, tea consumption, type of work, years of work, workload (%CVL), work clothing, heat stress, and dehydration (BJU) were associated with indications of impaired kidney function eGFR (CKD-EPI). Water consumption, consumption of sweet drinks, and workload (observation) are associated with indications of impaired uKIM-1 kidney function. The model formed is HeGFR(t) = h0 (t) exp (0.393 occupational heat exposure + 0.551 water consumption + 0.339 coffee consumption + 1.446 workload (%CVL) + 0.865 work clothes) Conclusion: occupational heat exposure is a risk factor for indications of impaired kidney function eGFR (CKD-EPI), taking into account other factors, namely water consumption, coffee consumption, workload (%CVL), and work clothing. Therefore, it is necessary to activate the Pos UKK to empower workers to carry out occupational safety and health activities.
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D-498
Depok : FKM-UI, 2024
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Dwi Septiawati; Promotor: Bambang Wispriyono; Kopromotor: Laila Fitria, Fathimah Sulistyowati Sigit; Penguji: Ririn Arminsih Wulandari, Besral, Yuanita Windusari, Nurjazuli, Lusyta Puri Ardhiyanti
D-641
Depok : FKM-UI, 2026
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Ruwayda; Promotor: Sutanto Priyo Hastono; Kopromotor: Evi Martha, Kemal Nazaruddin Siregar; Penguji: Anhari Achadi, Rita Damayanti, Ade Jubaedah, Muldiasman, Dwi Tyastuti
Abstrak:

ABSTRAK

Latar Belakang: Tingginya angka kematian ibu dan neonatus di Indonesia dipengaruhi oleh berbagai faktor, termasuk kualitas pelayanan kesehatan ibu dan anak (KIA) yang belum mencapai target. Kinerja bidan desa, sebagai ujung tombak pelayanan, dipandang sebagai salah satu faktor krusial yang dapat ditingkatkan melalui supervisi dari bidan koordinator puskesmas. Meskipun demikian, data menunjukkan pelaksanaan supervisi fasilitatif KIA di provinsi Jambi pada tahun 2022 dan 2023 baru mencapai 10.86% dan 17.38% dari target 90%. Khususnya di kabupaten Muaro Jambi, capaiannya lebih rendah lagi, yaitu 11.64% (2022) dan 15.07% (2023). Kesenjangan ini menunjukkan perlunya intervensi strategis untuk meningkatkan kualitas supervisi demi mengoptimalkan kinerja bidan dalam pelayanan KIA.
Tujuan: Mengetahui pengaruh model integrasi midwifery opinion leader dan supervisi fasilitatif terhadap kinerja bidan dan dampaknya pada cakupan pelayanan kesehatan ibu dan anak di Provinsi Jambi tahun 2025.
Metode Penelitian: Penelitian ini merupakan penelitian mixed methods exploratory sequential design terdiri dari 3 tahap yaitu tahap I diawali scoping review, studi pendahuluan dan uji coba instrumen dilanjutkan identifikasi kebutuhan model menggunakan metode kualitatif dengan desain phenomenology. Tahap II meliputi pengembangan model, panel expert, pelatihan dan uji coba model. Tahap III dilakukan uji model terhadap kinerja bidan dengan indikator standar kompetensi kinerja (SKK) dan cakupan pelayanan KIA dengan penelitian quasi experiment pretest-posttest with control designs. Populasi adalah seluruh bidan desa/pustu di provinsi Jambi. Sampel yaitu kelompok intervensi sebanyak 60 responden (di kabupaten Muaro Jambi) dilakukan intervensi model integrasi MOL dan supervisi fasilitatif, sedangkan kelompok kontrol 60 responden (di kota Jambi) dilakukan hanya supervisi fasilitatif. Waktu penelitian pada bulan Mei 2024 hingga Agustus 2025, analisis data dengan univariat, bivariat dan multivariat (Difference in Difference).
Hasil: Berdasarkan identifikasi kebutuhan ditemukan subtema: kinerja bidan, kebutuhan supervisi dan model supervisi. Selanjutnya dilakukan pengembangan model supervisi dengan pendekatan teori COM-B, supportif supervision, midwifery leadership dan coaching sehingga diperoleh model midwifery opinion leader (MOL) yang dapat diintegrasikan dengan program supervisi fasilitatif KIA puskesmas. Hasil uji penerimaan model diperoleh hasil skor tertinggi yaitu sikap terhadap penggunaan rata-rata 4.9 dan terendah yaitu persepsi manfaat dengan skor 4.71. Hasil analisis diff in diff diketahui pada 2 kelompok sebelum dan sesudah intervensi terhadap skor standar kompetensi kerja: penataan pelayanan 1.36(0.24-1.60), asuhan bayi baru lahir 2.36(0.75-3.12) pemeriksaan kehamilan 1.33(0.48-1.82), pemeriksaan ibu bersalin 1.93(1.72-3.65) dan asuhan ibu nifas 1.43(0.30-1.74).Uji dampak model terhadap cakupan KIA yaitu: kunjungan ibu hamil ke-4 (K4)18.25(3.83-22.08), persalinan nakes (PN) 15.53(3.47-19.00), kunjungan nifas (KNF) 15.59(3.41-19.00), kunjungan neonatal lengkap (KNL) 14.35(9.97-24.33), kunjungan bayi (KBY) 19.08 (7.26-26.35) dan kunjungan balita (KBAL) 5.81 (16.14-21.95).
Kesimpulan dan Saran: Model integrasi Midwifery Opinion Leader (MOL) dan supervisi fasilitatif berpengaruh dalam meningkatkan kinerja bidan dalam pelayanan KIA. Disarankan mempertimbangkan model ini dalam kegiatan program supervisi kesehatan ibu dan anak di Puskesmas.

ABSTRACT


Background: The high maternal and neonatal mortality rates in Indonesia are influenced by various factors, including the quality of maternal and child health (MCH) services, which have not yet reached their targets. The performance of village midwives, as the frontline of service delivery, is seen as a crucial factor that can be improved through supervision by health center coordinator midwives. However, data shows that the implementation of facilitative MCH supervision in Jambi province in 2022 and 2023 has only reached 10.86% and 17.38% of the 90% target. In Muaro Jambi district, in particular, the achievement was even lower, at 11.64% (2022) and 15.07% (2023). This gap indicates the need for strategic interventions to improve the quality of supervision in order to optimize the performance of midwives in MCH services.
Objective: To determine the effect of the midwifery opinion leader integration model and facilitative supervision on midwives' performance and its impact on the coverage of maternal and child health services in Jambi Province in 2025.
Research Method: This research is a mixed methods exploratory sequential design consisting of 3 stages, namely stage I, which begins with a scoping review, preliminary study, and instrument testing, followed by the identification of model requirements using a qualitative method with a phenomenology design. Stage II includes model development, expert panel, training, and model testing. Phase III involved testing the model on midwives' performance using standard competency performance (SKK) indicators and MCH service coverage using a quasi-experimental pretest-posttest with control designs. The population consisted of all village midwives/health workers in Jambi Province. The sample consisted of an intervention group of 60 respondents (in Muaro Jambi district) who underwent the MOL integration model intervention and facilitative supervision, while the control group of 60 respondents (in Jambi city) only underwent facilitative supervision. The research period was from May 2024 to August 2025, with data analysis using univariate, bivariate, and multivariate (Difference in Difference) methods.
Results: Based on the identification of needs, the following sub-themes were found: midwife performance, supervision needs, and supervision models. Subsequently, a supervision model was developed using the COM-B theory, supportive supervision, midwifery leadership, and coaching approaches, resulting in a midwifery opinion leader (MOL) model that can be integrated with the KIA puskesmas facilitative supervision program. The model acceptance test results showed the highest score for attitude toward use, with an average of 4.9, and the lowest score for perceived benefits, with a score of 4.71. The results of the diff in diff analysis showed that in the two groups before and after the intervention, the standard work competency scores were: service management 1.36 (0.24-1.60), newborn care 2.36 (0.75-3.12), pregnancy check-ups 1.33 (0.48-1.82), maternity check-ups 1.93 (1.72-3.65), and postpartum care 1.43 (0.30-1.74). The model's impact on MCH coverage was as follows: fourth antenatal visit (K4) 18.25 (3.83-22.08), skilled birth attendance (PN) 15.53 (3.47-19.00), postnatal visit (KNF) 15.59 (3.41-19. 00), complete neonatal visits (KNL) 14.35 (9.97-24.33), infant visits (KBY) 19.08 (7.26-26.35), and toddler visits (KBAL) 5.81 (16.14-21.95).
Conclusion and Recommendations: The integration model of Midwifery Opinion Leader (MOL) and facilitative supervision has an impact on improving midwives' performance in maternal and child health services. It is recommended to consider this model in maternal and child health supervision program activities at health centers.

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D-603
Depok : FKM-UI, 2025
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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Elly, Nur/ Promotor: Djuwita, Ratna/ Kopromotor: Purwantyastuti; Rimbawan/ Penguji: Laksminingsih, Endang; Rini Sekartini, Besral, Mira Dewi, Noer Laily
D-396
Depok : FKM-UI, 2019
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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:: Pengguna : Pusat Informasi Kesehatan Masyarakat
Library Automation and Digital Archive